Healthcare Provider Details

I. General information

NPI: 1508520834
Provider Name (Legal Business Name): CAMPBELL'S PREMIER PHYSICAL THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2021
Last Update Date: 10/26/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 E HAMILTON AVE
CAMPBELL CA
95008-0245
US

IV. Provider business mailing address

163 E HAMILTON AVE
CAMPBELL CA
95008-0245
US

V. Phone/Fax

Practice location:
  • Phone: 408-866-5567
  • Fax: 408-866-1317
Mailing address:
  • Phone: 408-866-5567
  • Fax: 408-866-1317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name: DERINDA GARLICK
Title or Position: OFFICE MANAGER/ADMINISTRATOR
Credential:
Phone: 408-866-5567